Provider Demographics
NPI:1144496449
Name:MAHAJAN, SHYAM SUNDAR (MD)
Entity type:Individual
Prefix:MR
First Name:SHYAM
Middle Name:SUNDAR
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CARLTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-989-9233
Mailing Address - Fax:973-989-9233
Practice Address - Street 1:53 CARLTON DRIVE
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-989-9233
Practice Address - Fax:973-989-9233
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA029554207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31363Medicare UPIN